9. why must TB disease must be treated for at least 6 months?

The aims of treatment of tuberculosis are: to to to to to cure the patient and restore quality of life and productivity; prevent death from active TB or its late effects; prevent relapse of TB; reduce transmission of TB to others; prevent the development and transmission of drug resistance.

10. Initial treatment of TB disease Isoniazid, rifampicin, pyrazinamid, and ethambutol 11. Why should at least two drugs be used to treat TB? Combination of the drugs can prevent resistance of the bacteria. A recent multicentre trial found that fixed dose combination have equivalent efficacy to single pill 12. Two factors that can lead to drug resistance - adherence to therapy / physician mistake - avoid monotherapy 13. What special situations should treatment for TB disease last longer than usual course? - In patients with confi rmed multidrug-resistant disease, therapy with at least two drugs to which the isolate is susceptible is recommended for at least 12 months after documented conversion of the cultures to negative results. Most experts recommend 18 to 24 months of total therapy. Patients with isoniazid-resistant TB can be treated with rifampin, pyrazinamide, and ethambutol for 6 to 9 months. Patients with rifampin-resistant TB should be treated with isoniazid, pyrazinamide, and ethambutol for at least 12 months after culture results convert to negative. - Children with miliary TB, bone/joint TB, or tuberculous meningitis should receive a minimum of 9 to 12 months of therapy. 14. Adverse reactions of the drugs Adverse reactions are not uncommon in the treatment of TB. Isoniazid, which is best known for its hepatotoxicity, also causes peripheral neuropathy, for which vitamin B6 (pyridoxine) is prescribed as prophylaxis. Rifampin may cause hepatotoxicity. Pyrazinamide can also cause hepatotoxicity as well as high uric acid levels, resulting in gout-like symptoms. Ethambutol is associated with optic neuritis, especially in doses of _ 20 mg/kg/d and in patients with renal insufficiency. 15. How often patients be monitored for adverse reaction?

Baseline liver function tests should be performed for all patients beginning treatment, and monthly monitoring is recommended for anyone with baseline abnormalities or concomitant liver disease. Clinical monitoring through regular inquiry of the patient as to the development systems of toxicity is recommended for all other patients. If transaminase levels become elevated and symptoms of hepatitis occur, therapy with all medications should be discontinued. Once signs and symptoms resolve or improve, medications should be reintroduced sequentially, and the patient should be monitored for the recurrence of hepatitis. The monthly assessment of visual acuity and color discrimination is recommended to identify patients who may have ethambutol toxicity.